Provider Demographics
NPI:1922162106
Name:EZPHARM PHARMACY
Entity Type:Organization
Organization Name:EZPHARM PHARMACY
Other - Org Name:EZPHARM, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-284-0020
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-0406
Mailing Address - Country:US
Mailing Address - Phone:860-284-0020
Mailing Address - Fax:860-201-1200
Practice Address - Street 1:166 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1200
Practice Address - Country:US
Practice Address - Phone:203-758-7227
Practice Address - Fax:203-758-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5301260001Medicare NSC